Provider Demographics
NPI:1467484626
Name:BURR, MARC A (DC)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:BURR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 LEAD MINE ROAD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3326
Mailing Address - Country:US
Mailing Address - Phone:919-781-8830
Mailing Address - Fax:919-781-1678
Practice Address - Street 1:4517 LEAD MINE ROAD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3326
Practice Address - Country:US
Practice Address - Phone:919-781-8830
Practice Address - Fax:919-781-1678
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790830PMedicaid
NC0830POtherBLUE CROSS BLUE SHIELD
2452597CMedicare ID - Type Unspecified
U73126Medicare UPIN
NC0830POtherBLUE CROSS BLUE SHIELD